Abstract
<jats:p>Aim. To demonstrate the complexity of selecting drug therapy in patients with post-stroke epilepsy using a clinical case. Key points. The mechanisms of interaction between direct oral anticoagulants and antiepileptic drugs (AEDs) remain poorly understood. Large-scale drug-drug interaction studies have not been conducted, and opposing effects may be observed in clinical practice even with the same drug combination. This article presents a clinical case of a 72-year-old patient who suffered a cardioembolic cerebral infarction followed by the development of post-stroke epilepsy. While taking valproic acid and dabigatran concomitantly, the patient developed gastrointestinal bleeding, prompting the replacement of dabigatran with rivaroxaban and the selection of another AED with a lower risk of drug-drug interaction. Conclusion. This clinical case highlights the potential risks of drug-drug interactions and demonstrates the complexity of selecting drug therapy in patients with post-stroke epilepsy.</jats:p>